Low Prevalence of Lung Obstruction, Restriction in COVID-19 After ICU Discharge

Researchers observed a low prevalence of lung obstruction and restriction and either mild or no cognitive impairment in patients with coronavirus disease 2019 (COVID-19) approximately 6 weeks after discharge from the intensive care unit (ICU), according to findings from a small case series published in CHEST.

A total of 102 patients who were admitted to a university medical center ICU with COVID-19 as of July 30, 2020, were included in this case series. All patients in underwent follow up at a post-COVID-19 ICU clinic around 6 weeks following discharge. Spirometry was used to assess lung function and exercise capacity. Lung volumes, diffusion capacity, and the 6-minute walking distance (6MWD) were also assessed.

The Patient-Reported Outcomes Measurement Information System depression 8a-short score, Quality of Life in Neurological Disorders (Neuro-QoL™) adult cognitive function v2.0 score, the Montreal Cognitive assessment (MOCA) scores, and insomnia severity index were used to assess depression, cognitive function, and insomnia.

The majority of patients (85.71%) required mechanical ventilation; the median number of days on ventilation was 11. The median ICU length of stay was 14 days and the median hospital length of stay was 22 days. Additionally, the median days to postdischarge clinic follow-up was 39.5 days.

A total of 57.84% (n=59) patients were discharged from the single center’s ICU alive, whereas 20.59% (n=21) remained hospitalized and 21.57% (n=22) died. As of July 30, 2020, a total of 28 of the 29 scheduled patients (median age, 56 years) attended the follow-up clinic (96% show rate).

Approximately 61.54% (n=16) of patients had normal lung function at follow-up, whereas 15.38% (n=4) had obstruction, 19.23% (n=5) had restriction, and 3.85% (n=1) had mixed obstruction and restriction. Reduced diffusion capacity was observed in 7 (26.92%) patients. No patient at follow-up required supplemental oxygen. In the follow-up cohort, the mean 6MWD was 315 meters.

Prior to hospital admission, none of the patients had clinically diagnosed depression, cognitive impairment, or insomnia. At follow-up, however, 7 patients had mild to moderate depression, and mild cognitive impairment was identified more frequently with MOCA (57.14%) than with Neuro-QoL (22%).

Most patients (96%) had no difficulty performing activities of daily living. Moderate to severe insomnia was identified in 5 of 23 patients who completed the insomnia severity assessment.

Study limitations included the single center case series design as well as the lack of longer term outcomes data for these patients.

While the investigators concluded the long-term effects of COVID-19 remains unclear, the findings suggest “the feasibility of an in-person outpatient clinic for post-ICU COVID-19 patients and a low burden of pulmonary and neurocognitive morbidity at immediate follow-up.”

Reference

Ramani C, Davis EM, Kim JS, Provencio JJ, Enfield KB, Kadl A. Post-intensive care unit COVID-19 outcomes-a case series. CHEST. Published online August 21, 2020. doi:10.1016/j.chest.2020.08.2056